Medical cognition is an area of research made popular since this 1998 paper by Vimla Patel as a further development in the field of Medical Informatics particularly to "examine human-computer interaction in medical contexts and computer-mediated collaborative processes."
It was a pleasure getting to know Prof Vimla since 2008 virtually through existing human computer interactive interfaces for social collaboration aka email groups and social media especially through her association with a National body that was developed to further medical Informatics research in India.
While the above paper used illustrations that were meant to be generalizable as per the prevailing paradigm there was another requirement in "medical cognition" that was evolving and waiting for quite a while having been addressed by other systems of medicine that didn't remain mainstream and that was around "answering multidimensional information needs" in individual patients and this was in someways a harbinger of developing a "case based blended learning ecosystem" aka CBBLE (pronounced "cable") that represented another pathway in medical cognition.
The first author is currently the director of SGPGI, Lucknow as well as VC, KGMU, Lucknow.
2000: The same CBBLE team member changed institutes two decades back and shared one more case based experience from Pokhara, Nepal here:
Slowly the realization dawned that individual case based experiences were different from the average data being represented in Clinical trials where each of these individuals was just a number.
2002: Contrary to what trial data projected, every individual was unique and had unique life trajectories and it was found that medical students were best suited to unearthing these trajectories as documented here: https://www.eubios.info/EJ124/
Some of these medical students who were now academic faculty, revisited this idea in the last CBBLE paper here: https://www.ncbi.nlm.nih.gov/p
2007: It was gradually becoming clearer that current evidence based medicine needed a more meaningful methodology to answer individual patient requirements here: https://pubmed.ncbi.nlm.
2008: And soon the first conceptual model for current CBBLE was shared here: http://www.ncbi.nlm.nih.
It was called "user driven healthcare" UDHC and described a prevalent phenomenon evolving with the internet and the only difference with the later CBBLE appears to be that the term "blended learning" got added to the same process suggesting that the CBBLE had a strong component of offline connection and locality that was blended to requirements of online users.
The CBBLE idea as a subset of the UDHC phenomenon was to build a Case based reasoning database that could offer any individual patient data a platform for obtaining comparisons between other individual patients who had similar data patterns and then see if near matches of individual trajectories would offer similar outcome trajectories in those group of patients and this was inspired by a seminal paper on case based reasoning linked here: https://pubmed.ncbi.nlm.
The pursuit of clinical problem solving using online user driven learning was a polymathic pluralistic activity and we derived a lot of lessons from other fields as illustrated in chapters of the UDHC book here
2009: The model could be scaled to the last mile primary care and act as an efficient bridge between primary and tertiary, individual home, community collaborative center and academic institutions as proposed here: https://pubmed.ncbi.nlm.nih.
2010-2020--
Many such cases started getting logged by last mile workers in various parts of India particularly West Bengal and they were processed by a CBBLE that fed case based problems to a global forum for conversational learning as shared here: https://www.ncbi.nlm.nih
The forum was made by global medical and engineering students and there is more about them in the above article as well as in the UDHC book and journal issues here https://www.igi-global.co
The Online links to some currently surviving patient records can be found in the online learning portfolios of the last mile worker users here below:
(The number in the URL reflects the area pin code from where the last mile worker operates).
These last mile workers had begun a new genre of multilingual, deidentified online patient records that were partially structured and managed in most instances to convey individual patient requirements and their work was further shared globally in published case studies linked below:
The paper below is a collated depiction of cases emailed by some of our last mile workers and how their differently structured patient histories were still useful to develop a learning ecosystem between the offline patient and online healthcare learner and helper.
The paper below is a case study that highlights our workflow of sharing "open access patient records with de-identified patient documentation such as doctors’ notes, diagnostic test results and the patient’s perspective" toward improving their outcomes along with students learning outcomes.
The original online patient record blog that was foundational to the published case study is accessible here: https://ebpc-udhc-debasi
With the steady progress of our last mile workers abilities to create web based logs of patient records the abilities of the medical students in our learning ecosystem remained at par by translating quite a few, perhaps 50-70 of these online patient records into journal publications accessible here https://pubmed.ncbi.nlm.n
2013 one of the activities of a team member who looked after the editorship of BMJ Case reports was to spread the word about case based learning and how every individual patient was an independent research project and below are links to some of the lectures delivered in
Bhopal PCOR 2014: http://www.pitt.edu/~super1/lecture/lec53081/001.htm
Bangalore 2015 http://www.pitt.edu/~super1/lecture/lec53671/002.htm
Delhi Banga Bhavan 2015 http://www.pitt.edu/~super1/lecture/lec53961/001.htm
2015 was particularly important as one medical college started funding research assistants who were more conversant with Hindi to take this work forward and below are some of their work in their multilingual online learning portfolios
RA1: Hindi online patient record
RA2: Link to online patient logs:
RA2: Link to one time assessment:
RA3: Link to one time assessment:
RA4: Link to online patient logs:
RA4: Link to one time assessment:
RA5: Link to online patient logs:
RA5: Link to one time assessment:
73 cases in this web based log book from LNMCH courtesy, research assistant, Kuldeep Gupta
46 cases in this web based log book from LNMCH courtesy, research assistant, Kuldeep Gupta
2016 end saw the migration to another beginning detailed in part 2 here http://medicinedepartment.blogspot.com/2021/06/evolution-of-model-forpatient-centered.html?m=1
